20110147 Ver 1_Application_20110214

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
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BEVERLY PURDUE P. O. Box 25201, Raleigh, NC 27611-5202 EUGENE CONTI, JR.
GOVERNOR PHONE: [phone] SECRETARY
February 9, 2011
Mr. Monte Matthews
U. S. Army Corps of Engineers
Raleigh Regulatory Field Office 110147
3331 Heritage Trade Drive, Suite 105
Wake Forest, NC 27587 -
Subject: Nationwide Permit 93
Replace Pipe #2278 on SR 1798
Surry County, North Carolina
Project Number: 11B.208611 (No DWQ Permit Fee Required)
Dear Mr. Matthews:
The North Carolina Department of Transportation is scheduled to replace Pipe #2278 with a new
pipe at the same location. Stream impacts are tabulated below:
Stream Impacts:
Station
'=.Number`' 'Existing,
Structure Size Proposed Rpe
: -Size Temporary
Dewaterifi ,, Riprap .` >
Im act§ feet Total Impacts at
'this Station ft. .

Pipe #2278 40'x 66" 50'x 72" w/ HW 40 20 70
Permanent FiIURi ra Impacts = 30 feet Total Project Impacts = 70 feet
The replacement of the existing pipe with the proposed new pipe will require temporary
dewatering. An impervious sandbag dike will be constructed approximately 20 feet upstream of
the existing structure to create a small pool. Clean water will temporarily be pumped around the
construction area and will be discharged downstream. Any dirty water located inside the
construction area will be pumped into a silt bag if necessary. Once the new structure is in place,
the impervious dike will be removed and preconstruction streambed elevations will be restored.
Construction of this project will require impacts to waters of the United States in the Roanoke
River Basin. The existing pipe crosses Meadow Branch (Class: C; Trout). This project was
reviewed for the presence of threatened and endangered species on February 4, 2011. The subject
project will have no effect on any federally listed endangered plant or animal species. Historic
P.O.Box250,N. WaKEsBORO,NC 28659
PHONE [phone] FAx [phone]
Mr. Monte Matthews
Pipe #2278 on SR 1798
Page 2
February 9, 2011
compliance work will be scheduled and concurrence with the State Historic Preservation Office
will be obtained if required.
The project impacts are not significant in nature and should not alter the best usage for this
stream. All appropriate BMPs will be used during construction. Attached is a Preconstruction
Notification Form, plan sheets, a marked county map and a marked topography map.
By copy of this letter, it is requested that Mr. Ron Linville, Mountain Region Coordinator, with
the North Carolina Wildlife Resources Commission comment directly to you concerning the 404
Nationwide Permit application with a copy sent to me.
We would like to begin construction as soon as possible. If further information is required, please
let me know. Your early review and consideration will be appreciated.
Sincerely,
Ad A4e
Heath Slaughter
Division Environmental Officer
Enclosures
cc: Monte Matthews, US Army Corps of Engineers (1 additional copy)
Ron Linville, Western Piedmont Region Coordinator, NCWRC
Brian Wrenn, Division of Water Quality (2 copies)
Mike Pettyjohn, PE, Division Engineer
David Wayne, PE, Division Bridge Maintenance Engineer
Heath Slaughter, Division Environmental Officer
Scott Pipes, Roadside Environmental Field Operations Technician
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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification PCN Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps: ® Section 404 Permit ? Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ? Yes ® No
l d. Type(s) of approval sought from the DWQ (check all that apply):
? 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorization

-
le. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
® Yes ? No For the record only for Corps Permit:

? Yes ® No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ® Yes ? No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. ? Yes ® No
th. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ®No
2. Project Information
2a. Name of project: Replace Pipe #2278 on SR 1798
2b. County: Surry
2c. Nearest municipality / town: Woodville
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state
project no: 11 B.20861 1
3. Owner Information
3a. Name(s) on Recorded Deed: NCDOT
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address: 801 Statesville Road
3e. City, state, zip: North Wilkesboro, NC 28659
3f. Telephone no.: 336-903-9202
3g. Fax no.: 336-667-4549
3h. Email address: [e-mail]
Page 1 of 10
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ? Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.: -
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name:
5b. Business name
(if applicable):
-
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 10
PCN Form - Version 1.3 December 10, 2008 Version
B. Project Information and Prior Project History
1. Property Identification
la. Property identification no. (tax PIN or parcel ID):

tb. Site coordinates (in decimal degrees): Latitude: 36.49421 Longitude: - 80.45542
(OD.DDDDDD) (-DO.DDOODD)
1c. Property size: 0.1 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project: Meadow Branch
2b. Water Quality Classification of nearest receiving water: C; Trout
2c. River basin: Roanoke
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
Substandard pipe to be replaced in a rural area
3b. List the total estimated acreage of all existing wetlands on the property:
0 acres
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
50 linear feet
3d. Explain the purpose of the proposed project:
Upgrade substandard stream crossing
3e. Describe the overall project in detail, including the type of equipment to be used:
See attached cover letter.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past?
Comments:

? Yes ® No ? Unknown
4b. If the Corps made the jurisdictional determination, what type
of determination was made? ? Preliminary ? Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known): Agency/Consultant Company:
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
S. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past? ? yes ® No ? Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ? Yes ® No
6b. If yes, explain.
Page 3 of 10
PCN Form - Version 1.3 December 10, 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
? Wetlands ® Streams - tributaries. ? Buffers
? Open Waters ? Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary
? Yes ? Corps
W1 ? P ? T ? No ? DWQ
? Yes ? Corps
W2 ? P ? T ? No ? DWQ
? Yes ? Corps
W3 ? P ? T ? No ? DWQ
? Yes ? Corps
W4 ? P ? T ? No ? DWQ
? Yes ? Corps
W5 ? P ? T ? No ? DWQ
? Yes ? Corps
W6 ? P ? T ? No ? DWQ
2g. Total wetland impacts
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ - non-104, width (linear
Temporary (T) (INT)? other) (feet) feet)
S1 ® P ® T Piping, Riprap & Meadow Branch ® PER
? INT ® Corps
® DWQ 3 70
Dewatering
? PER ? Corps
S2 ? P ? T ? INT ? DWQ
? PER ? Corps
S3 ? P ? T ? INT ? DWQ
? PER ? Corps
S4 ? P ? T ? INT ? DWQ
? PER ? Corps
S5 ? P ? T ? INT ? DWQ
? PER ? Corps
S6 ? P ? T ? INT ? DWQ
3h. Total stream and tributary impacts 70
3i. Comments: 40 linear feet of the impacts are temporary
Page 4 of 10
PCN Form - Version 1.3 December 10, 2008 Version
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below. -
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number - (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Temporary T
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4f. Total. open water impacts
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f. Total
5g. Comments: N/A
5h. Is a dam high hazard permit required?
? Yes No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an impacts require mitigation, then you MUST fill out Section D of this form.
6a.
? Neuse ?Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number- Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary impact required?
Bt ?P?T ?Yes
? No
B2 ? P ? T ? Yes
? No
B3 ?P?T ?Yes
? No
61L Total buffer impacts
6i. Comments:
Page 5 of 10
PCN Form - Version 1.3 December 10, 2008 Version
D. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The pipe length is the minimum needed to improve safety at this location. Utilization does not warrant a bridge.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
All appropriate BMPs will be used during construction
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State? ® Yes ? No
2b. If yes, mitigation is required by (check all that apply): ? DWQ ® Corps

2c. If yes, which mitigation option will be used for this
project?
' ? Mitigation bank
® Payment to in-lieu fee program

? Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4. Completed Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
4b. Stream mitigation requested: 10 linear feet
4c. If using stream mitigation, stream temperature: ® warm ? cool ?cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: aces
4h. Comments:
5. Complete if Using a Perrnittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form - Version 1.3 December 10, 2008 Version
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ? Yes ®No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.

Zone 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund). -
6h. Comments:
Page 7 of 10
PCN Form - Version 1.3 December 10, 2008 Version
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified ? Yes ®No
within one of the NC Riparian Buffer Protection Rules?
tb. If yes, then is a diffuse flow plan included? If no, explain why.
? Yes ? No
Comments:
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? %
2b. Does this project require a Stormwater Management Plan? ? Yes ®No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
? Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ? DWQ Stormwater Program
? DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local governments jurisdiction is this project?
? Phase II
? NSW
3b. Which of the following locally-implemented stormwater management programs ? USMP
apply (check all that apply): ? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ? No
attached?
4. DWQ Stormwater Program Review
? Coastal counties
? HOW
4a . Which of the following state-implemented stormwater management programs apply ? ORW
(check all that apply): ? Session Law 2006-246
? Other:
4b . Has the approved Stormwater Management Plan with proof of approval been
? Yes ? No
attached?
5. DWQ 401 Unit Stormwater Review
5a . Does the Stormwater Management Plan meet the appropriate requirements? ? Yes ? No
5b . Have all of the 401 Unit submittal requirements been met? ? Yes ? No
Page 8 of 10
PCN Forth - Version 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
I a. Does the project involve an expenditure of public (federal/state/local) funds or the ® Yes ? No
use of public (federal/state) land?
tb. If you answered 'yes" to the above, does the project require preparation of an
t
St
? Yes
®No
e
a
environmental document pursuant to the requirements of the National or
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
I c. If you answered `yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
? Yes
? No
letter.)
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ? Yes ®No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ? Yes ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a . Will this project (based on past and reasonably anticipated future impacts) result in ? Yes ® No
additional development, which could impact nearby downstream water quality?
3b . If you answered 'yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a . Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
N/A
Page 9 of 10
PCN Form - Version 1.3 December 10, 2008 Version
S. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or ? Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ? Yes ® No
impacts?
? Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
ill
? A
h
ev
e
s
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
GIS and visual observation
6. Essential Fish Habitat (Corps Requirement) -
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
WRC will comment
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation ? Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ? Yes ®No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? ncfloodmaps
7. Heath Slaughter ?k A9?IA 2/9/11
Applicant/Agent's Printed Name Applicant/Agent's Sid ture Date
(Agent's nature is valid only if an author on letter from the applicant
is provided.)
Page 10 of 10
PCN Form - Version 1.3 December 10, 2008 Version
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PROJECT:I
IIB.208611
ROAD: SR 1798 PIPE # 2278
COUNTY. SURRY
TYPE: PIPE REPLACEMENT
DATE: 21W]

PROPOSED PIPE DIMENSIONS
1 LINE(S) OF 50'X 72° CMP WITH HEADWALL
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PROPOSED CONCRETE HEADWALL EXISTING PIPE DDIENSIONS
40'LONG X 66°ROUND GNP

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IMPERVIOUS DIKE

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NOTE. TEMPORARY EROSION CONTROL DEVICES NOT SHOWN.
STREAM NAME: MEADOW BRANCH
STREAM CLASSIFICATION: C, TR.
AVERAGE STREAM WIDTH: T WIDE SURVEY DATE: 12641
CONDUCTED BY: DW
DRAWN BY, DW